In the early days of COVID-19, one of the patrons of Pottsboro Area Library, TX, got in touch with Director Dianne Connery with a dilemma. The patron had undergone an MRI just before the pandemic began, and her doctor wanted to discuss the results. Unfortunately, she also had a medical condition that made her doctor wary of bringing her into potential contact with anyone suffering from COVID. So the doctor proposed a video call.

“She didn’t have [broadband] connectivity at home, so she came to the library,” Connery says. Connery loaned the patron her own laptop and office to use the library’s broadband; problem solved. Shortly after that, another patron who also didn’t have broadband at home approached Connery about setting up a video call with a veterans’ hospital. Realizing that there could be growing demand for these types of services, Connery applied for and received a grant from the National Library of Medicine to retrofit a small storage room to give patrons privacy during their video calls. With that, Pottsboro became one of the first public libraries in the United States to promote telehealth services.

SHOW OF SUPPORT Delaware officials have helped fund the state library’s teleservices initiatives. l-r Secretary of State Jeff Bullock, State Librarian Annie Norman, Statewide Social Innovator Alta Porterfield, Congresswoman Lisa Blunt Rochester, Denee Crumrine of Highmark Health, former Emerging Tech Consultant Nick Martin, and Carl Shaw of Wilmington Library.

In many ways, Connery’s case illustrates why telehealth is a natural fit for libraries in many communities. Pottsboro is a rural town of 2,600 residents where home broadband infrastructure is limited, and while there are healthcare facilities within a 30-minute drive, medical specialists are often located in cities much farther away. The library is a welcoming place offering privacy for confidential meetings, and if a patron has trouble setting up a videoconference, Connery is there to help.

“I read some things—especially during the beginning of COVID—about how much time providers were wasting on telehealth calls because people were muted,” or were experiencing other technical problems, Connery says. “Librarians are just perfectly positioned for this. [We have] the fastest internet in town, we’re used to helping people with this kind of stuff, and we respect privacy.”

While Connery was getting Pottsboro’s program running, plans were already underway at the Delaware Division of Libraries (DDL) to launch telehealth pilot tests at the state’s Seaford, Laurel, and Milford libraries. Grant funding from Barclays US Consumer Bank, the Delaware Community Foundation, the Delaware Department of Health and Social Services’ Division of Public Health, the Crystal Trust Foundation, Discover Bank, Highmark Blue Cross Blue Shield Delaware, the Longwood Foundation, and the Welfare Foundation enabled DDL to install small, soundproof booths developed by TalkBox and equipped with UV sanitation and HEPA filtration features. Patients were given iPads preloaded with teleservice apps to connect with their doctor or have consultations with DDL’s extensive network of healthcare partners, and part-time staff specialists were available to help schedule appointments or assist with technology.

Inspired partly by DDL’s telehealth pilot, Michele Stricker, deputy state librarian for the New Jersey State Library, also began researching ways that the state’s libraries could potentially offer telehealth services. Ultimately, she decided that DDL’s model would be difficult to replicate and scale. Instead, she turned to Karen Parry, information services manager at the East Brunswick Public Library, NJ, (EBPL) and founder of Just for the Health of It!, a health literacy and patron health research service—featuring partnerships with more than 65 hospitals and health care providers throughout the state—that Parry had been running at EBPL since 2009. (Parry was recognized as an LJ Mover & Shaker for the program in 2018. Stricker was recognized as a 2019 Mover & Shaker for her development of The Librarian’s Disaster Planning and Community Resiliency Guidebook and Workbook toolkit.)

“Hospitals see libraries as very strong partners in the changing landscape of healthcare,” Parry says. “Libraries are what they call ‘upstream medicine.’ We’re the first place people often come [to learn more about a condition or illness]. They see us as a welcoming place…. And immigrants turn to libraries so frequently for health information.”

With the help of funding from the American Rescue Plan Act (ARPA) and the Institute of Museum and Library Services, Stricker and Parry developed NJHealthConnect @ Your Library, initially a nine-month project that launched in early 2022. The program distributed 450 iPads to more than 150 communities in New Jersey, focusing on areas that ranked higher on the State of New Jersey Department of Community Affairs Municipal Revitalization Index. Remotely managed by EBPL’s IT staff using mobile device management software, the iPads are all preloaded with telehealth apps from multiple New Jersey hospitals, as well as apps and links to mental health organizations, Google Meet and Zoom, crisis hotline information, health literacy information from Medline Plus and EBPL’s own Just For the Health of It! portal, and more. Libraries were also given training on health literacy programming from EBPL—in many cases by Parry herself—as well as social media messaging tips and ready-made flyer templates to facilitate local outreach for the program.

“I think [Parry] got the right mix of what to put on these iPads for who we were trying to reach, and it was a very simple program for our librarians to implement,” Stricker says. “They could check out the iPads using their own lending policies. They were Wi-Fi only, and we asked [participating libraries] that if they wanted to have patrons use them in the library to have a private space for them. Or they could let [patrons] take them home if they wanted to. But literally, all [participating libraries] needed to do was check them back in, and any [personal] health information was wiped off” by EBPL’s mobile device management software.

ALREADY ADAPTING

With the help of additional grants and federal funding, Delaware has expanded both the size of its program and the scope of its mission in recent months, rebranding it from “telehealth” to “teleservices” to highlight that patrons can use the Talkbox kiosks or, in some libraries, small rooms, to hold private, live video meetings not only with doctors but also with immigration lawyers, therapists, prospective employers, or government agencies, to cite a few examples, explains Salena Carrillo, teleservices assistant administrator for DDL. And these services are “officially now at 13 libraries throughout the state…five libraries in Sussex County, one in Kent County, and then seven in New Castle County,” she says. Nine locations have Talkbox kiosks, and four have retrofitted rooms. The program now employs eight part-time teleservices specialists who each work 20 hours per week, often splitting time between two teleservices locations.

GET CONNECTED These flyer templates helped New Jersey libraries promote the statewide program locally.

Libraries with dedicated telehealth spaces are unlikely to have them booked solid with doctor visits, so encouraging patrons to reserve them for other types of private virtual meetings can help ensure that these spaces are well-used. Alta Porterfield, statewide community resources administrator for DDL, says that the organization had planned from the beginning to highlight a variety of ways the booths and rooms could be used, but telehealth took precedence during the pandemic. In-person outreach promoting telehealth then led the library to learn about other patron needs. For example, immigration teleservices are promoted partly because people from a local Haitian Creole community requested them.

“That’s just kind of the secret sauce of the specialists,” Porterfield says. “They’re taking these intakes and hearing their stories. Once a person gets comfortable with you, you find out all these other needs.”

These insights from specialists are valuable, and they help ensure that patron teleservices visits go smoothly. But to continue boosting usage, DDL is also working on ways to encourage self-service use of the kiosks and retrofitted rooms.

“The problem is funding,” Porterfield says. “These specialists…are wonderful, and they can help people in so many different ways, but we only can afford so many hours a day.” The libraries already have the ability to do online scheduling for the kiosks and rooms, and DDL is looking into creating a video to demonstrate how to use their libraries’ teleservices during hours when a specialist is not available.

New Jersey’s program has also promoted the tablets as a way to participate in remote job interviews, and Parry says she has heard of patrons even using them for virtual court appearances. “I look at it this way: The social determinants of health really are determined by where you live, work, and play,” she says, describing uses such as job seeking as tied into the program’s health-focused mission. “The World Health Organization has said that employment is a social determinant of health, and if you don’t have a job, you probably don’t have health insurance, so you get diagnosed at a later stage of disease,” she explains. So it has been important to promote that the iPads can also be used “for employment, for legal reasons,” Parry says. “Our [Just for the Health of It!] portal has resources for housing…. We wanted people to have access to health information in the full scope.”

And leaders overseeing all three of these programs say that mental health has become a component of their services, or is under consideration as something to promote.

At Pottsboro, “we are exploring the telehealth service being part of a bigger mental health services program,” Connery tells LJ. “Caseworkers/social workers will be using the space both for virtual and in-person appointments.”

And while the rollout of NJHealthConnect @ Your Library was completed last year, participating libraries still have the iPads, their training, and their insights from working with patrons on health literacy during the past year and a half. “When libraries do things like telehealth, go out in the community and do education and instruction to improve community health, whether it’s mental or physical…when mayors and funders hear about things like that, they are not going to push back” against funding requests, Parry says. “They’re much less likely to cut budgets.”

Parry and Stricker add that encouraging the state’s libraries to look for ways to offer mental health services as part of their broader health literacy and telehealth services is in alignment with recent government initiatives. “Our state governor [Phil Murphy] recently put out a statement about teens and mental health, and we’re aligning with that,” Stricker explains. Parry says, “I tell people, for every one teen that comes in the library who is healthy, there are 10 more [in the community] that we aren’t serving who have depression, who have alcohol problems, who have anxiety.”

ONGOING CHALLENGES

In the wake of the pandemic, teleconference meetings have become ubiquitous in many fields, making teleservices technology an important component in bridging the digital divide. But if a library plans to go beyond lending tablets, laptops, and Wi-Fi hotspots to offer telehealth access or other specific services—especially if a library is creating a dedicated space for private meetings—any new program will need regular promotion and outreach to ensure that it is well used.

For DDL, getting its telehealth program going involved in-person outreach at community centers and places of worship, local advertising, social media, flyers, programs with healthcare partners, and, of course, the dedicated part-time specialists who are prepared to explain the services and offer hands-on help at their branch.

And while rolling out NJHealthConnect @ Your Library, “Karen [Parry] sent out—during the duration of the grant—every week marketing tips to the libraries, so that they knew how to talk about this and market it to their community,” Stricker says.

The libraries that got the most out of the program “weren’t the ones with the most money,” Parry says. Generally, the usage of the tablets tracked the library’s enthusiasm about the program and interest in promoting it. In fact, while telehealth services might seem to be a more natural fit for libraries in rural communities with limited broadband infrastructure, Parry says that one New Jersey library serving a very wealthy suburb of New York City drew high usage from au pairs working for families in the area.

Currently, telehealth in libraries is a new and innovative service, and the libraries that have launched programs are generally doing so with grants or ARPA funding. However, Connery believes libraries should already be thinking of sustainable ways to keep these programs running long-term.

“I think we need to have a bigger discussion about reimbursement,” she says. Connery advocates for libraries to receive a portion of the healthcare provider’s fee for telehealth visits conducted at the library. “If this goes widespread, I don’t want to see five or 10 years from now that this is a standard service of libraries, [but] we don’t get any reimbursement, and the healthcare providers get all of it.” Libraries “just keep adding on new responsibilities. So every time I’m talking to a group like Medicaid [or] big insurance companies, I mention, ‘Let’s start talking about how libraries can get a piece of that funding.’”

But for now, these programs are clearly serving an emerging need for many patrons in these communities. “We have to keep changing,” Porterfield says. “We have to be flexible, right? That’s what we learned in the pandemic. You’ve got to be nimble. You’ve got to keep trying different things.”